Severe bleeding in the ICU

Abstract

Purpose of reviewSevere bleeding events, which require blood transfusions, are a challenge faced by many critical care physicians on a daily basis. Current transfusion guidelines generally recommend rather strict transfusion thresholds and strategies, which can appear opposing to a patient in need for urgent transfusion at first sight. Moreover, applied guidelines are lacking evidence and specificity for the typical ICU patient population and its comorbidities. Transfusion decisions, which are pivotal for clinical outcome, are often unsatisfactorily based on hemoglobin levels only. Recent findingsRecent publications generally support previous studies that a strict transfusion regimen is superior to a liberal one for the majority of cases. Newly developed and easily feasible techniques are currently in clinical trials and have the potential to become a valuable supplementation to hemoglobin-guided decisionmaking. In addition to the choice of the ideal transfusion strategy, physiological status and comorbidities were found to have a major impact on the outcome of severe bleedings in the ICU.

Preoperative anaemia and red blood cell transfusion in patients with aneurysmal subarachnoid and intracerebral haemorrhage — a multicentre subanalysis of the German PBM Network Registry

“…Further studies are needed to prove the potential beneficial effects of RBC transfusion on anaemic aSAH patients suffering from cerebral vasospasm. In the field of critical care, there is a growing evidence that strict transfusion limits remain best practice for the vast majority of cases, due to limited adverse effects, comparable or better clinical outcomes and economic aspects [ 28 ]. Thus, a restrictive threshold for RBC transfusions (Hb < 7 g/dl) is still recommended in both critically ill and clinically stable ICU patients [ 23 ].…”